For home and community based providers, Missouri Medicaid Audit and Compliance (MMAC) wishes to provide the following audit guidelines. We hope this will assist you with preparation for an audit, and also help you properly retain adequate documentation and help you bill MO HealthNet properly, regardless of whether you are subject to an audit or not.
MMAC will notify you of an on-site audit prior to arrival, in most instances. Unannounced audits are rare. MMAC will accommodate your needs and schedule, within reason. We will generally provide you a partial list of participants and dates of services that are part of our review (audit.) This is so you can begin to prepare and pull records prior to our arrival. We will send this partial list to you by fax or email. We will provide the complete list upon arrival. MMAC generally needs a place for two auditors and their two laptop computers and scanners, in order to properly scan records.
The following items are typically the items MMAC will request and review:
- The plan of care, or Web Tool print-out (or LTACS) for each participant being reviewed, within the review period
- Any and all documents that support services billed for each participant, for the dates of service within the review period. This may include timesheets, whether paper or EVV (telephony), or any other supporting documents
- Copies of the initial employee FCSR screenings, (for employees who are part of the review period)
- Copies of Good Cause Waiver requests and their outcomes (for employees who are part of the review period)
- Documentation to support billing for Authorized Nurse Visits
- MMAC may also request one complete participant file and one complete employee file while on-site
For Residential Care Facilities (RCFs):
- MMAC may request service delivery logs, and/or any documents that show services provided
- MMAC may request census records, medication administration records, or nurse’s notes for the time period being reviewed
- MMAC may request evidence of employee background screening
As well, for quality assurance purposes, MMAC may request
- Documentation for two employees or attendants which verifies initial and ongoing training requirements were met. This includes classroom training and on the job training. This also includes any training waivers and those supporting documents
- Verification of liability insurance and a dishonesty bond
For Consumer Directed Services (CDS) vendors:
- A verification that the consumer was trained by the provider regarding recruiting, hiring, supervising the attendant, etc.
- A verification that the appropriate tax forms have been complete and are on file with the vendor